Resuscitation

There has been much discussion over the years about resuscitation in the setting of hospice and palliative care. Resuscitation should be part of broader discussions around advance care planning with patients and their families. These discussions should be facilitated as early as possible, although in reality they continue to occur late in the illness trajectory, and sometimes are only raised when death is imminent. One study highlighted the fact that patients are not always aware of their prognosis; therefore, if resuscitation is discussed early in the course of their illness, decision-making around resuscitation will improve. [1] Another study found that the provision of written information about resuscitation was acceptable to patients but needed to be accompanied by a discussion regarding prognosis. [2]

These discussions (and subsequent decisions regarding ‘to resuscitate’ or ‘not to resuscitate’) should always be clearly documented to avoid confusion as the need to act on the decision arises. Documentation includes not only case notes or community notes, but also Advance Directives.

This situation will sometimes result in nurses not knowing whether to undertake resuscitation attempts or not. This can be especially difficult if for example, someone is imminently dying and their family are advocating for resuscitation (whether documentation is in place or not). Communication with patients and their families around decision making needs to take place early, so that these issues can be raised and conflicts potentially avoided later.

Websites

The Southern Cross Bioethics Institute website provides access to information on Bioethical legislation in Australia, much of which is relevant to palliative care. It can be different in each state and territory